What is the Tone Management Program?

Children with spasticity or dystonia – from conditions like cerebral palsy (CP), spinal cord injury or traumatic brain injury – may move more easily and feel more comfortable if they have treatments that control muscle tone.

The Tone Management Program evaluates and treats babies, children and adolescents with high muscle tone who might benefit from therapy, medicines, surgery or other options.

How will the Tone Management Program meet my child’s needs?

Seattle Children’s experts provide a complete range of medical and surgical treatments to manage high muscle tone and help your child with function as well as comfort.

    • Specialists from Neurosurgery, Orthopedics, Rehabilitation Medicine, Occupational Therapy and Physical Therapy work together in the Tone Management Program to evaluate your child’s unique needs and consider all the treatment options.
    • We design an individualized plan for your child, combining treatments and carefully timing them to get the best results.
    • Close coordination between neurosurgeons, orthopedic surgeons, rehabilitation medicine doctors, occupational therapists, physical therapists and other team members means your child gets comprehensive care and the process is easier on your family.
    • Based on your child’s condition, your child may see providers from other areas of Seattle Children’s too, such as our Neurodevelopmental team. We involve and partner with any experts your child needs, both here and in the community.
    • Our Child Life specialists and Guest Services help with your child’s and family’s experience.

    • Seattle Children’s is the only pediatric hospital in the Pacific Northwest to offer selective dorsal rhizotomy (SDR) as well as intrathecal baclofen (ITB) pump implants (PDF) for children who need neurosurgery to relieve spasticity.
    • Our Surgical Tone Management Clinic sees children who might benefit from neurosurgery. The clinic brings together all team members to evaluate your child in a single day – and often to recommend a care plan that same day before you leave. The same team plans and performs your child’s procedure and provides follow-up care.
    • Our orthopedic surgeons perform surgeries to address problems caused by high tone, like single-event multilevel surgery (SEMLS) and surgery to release shortened muscles in the hand and arm that restrict movement.
    • To help your child get the most benefit from surgery, our rehabilitation doctors, occupational therapists and physical therapists design and provide individualized therapy, including the intensive rehab children need after SDR or SEMLS.
    • Watch videos about SDR, how it’s done at Seattle Children’s and the inpatient rehabilitation that children have after surgery.

    • Many children we see in the Tone Management Program do not need surgery, and we help them manage their spasticity with a range of other options.
    • Our Rehabilitation Medicine experts provide medicines taken by mouth as well as injections of Botox (botulinum toxin) and phenol to reduce spasticity and control dystonia.
    • Physical and occupational therapy may stretch your child’s muscles and tendons to improve range of motion and function. Our therapists have special training and skills for managing movement disorders.
    • Orthotics and bracing can support your child’s body or help them move.
    • We may recommend changes to your child’s wheelchair or other equipment. Seattle Children’s has seating and equipment specialists to help with this.

Who’s on the team?

Neurosurgeons, orthopedic surgeons, rehabilitation doctors and other rehab experts see children in the Tone Management Program.

Providers in the program include:

Tone Management Program manager

  • Erin Hooper, RN, BSN

Neurosurgeon

Orthopedic surgeons

Rehabilitation doctors

Rehabilitation nurse practitioner

Rehabilitation nurses

  • Wendy Huynh, RN, CRRN
  • Pauline McCoubrey, RN, CRRN
  • Kiko VanZandt, RN, CRRN

Occupational therapist

  • Marla Ellingsen-Totah, OTR/L

Physical therapists

  • Jill Layman, PT, MPT, PCS
  • Connie Leibow, PT, MPT, PCS

Scheduling an Appointment with the Tone Management Program

Prepare for Your Visit to the Tone Management Program

What to Bring

  • Shorts for your child to wear during the exam so we can see their knees
  • Braces/Orthotics that are currently worn, too small or poor fitting
  • Gait aides like arm crutches, canes and walkers
  • Wheelchair (manual or power)